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Wegovy — Cigna

Continuing therapy for reduction of major adverse cardiovascular events risk in patient with established cardiovascular disease who is overweight or obese

Reauthorization criteria

  • Patient is age ≥ 18 years; AND
  • At baseline, patient had a BMI ≥ 27 kg/m2 [documentation required]; AND
  • Patient meets ONE of the following (a, b, or c): a) prior myocardial infarction [documentation required]; OR b) prior stroke [documentation required]; OR c) history of symptomatic peripheral arterial disease as evidenced by ONE of the following [(1) Intermittent claudication with ankle-brachial index < 0.85; OR (2) Peripheral arterial revascularization procedure; OR (3) Amputation due to atherosclerotic disease] [documentation required]; AND
  • According to the prescriber, the medication will be used in combination with optimized pharmacotherapy for established cardiovascular disease; AND
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet.